Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis

Philip Hamann, Gavin Shaddick, Kimme L. Hyrich, Amelia Green, Neil McHugh, John D Pauling

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Abstract

Objectives: To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in rheumatoid arthritis (RA)Methods: Paired DAS28-ESR and DAS28-CRP readings (n=31,074) were obtained from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated. Results: DAS28-CRP scores were ~0.3 lower than DAS28-ESR overall, with greatest differences for women (-0.35) and patients over 50 years old (-0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity (LDA) and remission thresholds (32.0% and 66.6% concordance respectively). Adjusting DAS28-CRP scores by gender significantly (p <0.001) improved agreement with the DAS28-ESR. Conclusion: Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.
Original languageEnglish
JournalRheumatology
DOIs
Publication statusPublished - 3 Oct 2018

Cite this

@article{e21383be54d548479f7f03cf7b845080,
title = "Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis",
abstract = "Objectives: To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in rheumatoid arthritis (RA)Methods: Paired DAS28-ESR and DAS28-CRP readings (n=31,074) were obtained from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated. Results: DAS28-CRP scores were ~0.3 lower than DAS28-ESR overall, with greatest differences for women (-0.35) and patients over 50 years old (-0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity (LDA) and remission thresholds (32.0{\%} and 66.6{\%} concordance respectively). Adjusting DAS28-CRP scores by gender significantly (p <0.001) improved agreement with the DAS28-ESR. Conclusion: Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.",
author = "Philip Hamann and Gavin Shaddick and Hyrich, {Kimme L.} and Amelia Green and Neil McHugh and Pauling, {John D}",
year = "2018",
month = "10",
day = "3",
doi = "10.1093/rheumatology/key374",
language = "English",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis

AU - Hamann, Philip

AU - Shaddick, Gavin

AU - Hyrich, Kimme L.

AU - Green, Amelia

AU - McHugh, Neil

AU - Pauling, John D

PY - 2018/10/3

Y1 - 2018/10/3

N2 - Objectives: To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in rheumatoid arthritis (RA)Methods: Paired DAS28-ESR and DAS28-CRP readings (n=31,074) were obtained from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated. Results: DAS28-CRP scores were ~0.3 lower than DAS28-ESR overall, with greatest differences for women (-0.35) and patients over 50 years old (-0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity (LDA) and remission thresholds (32.0% and 66.6% concordance respectively). Adjusting DAS28-CRP scores by gender significantly (p <0.001) improved agreement with the DAS28-ESR. Conclusion: Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.

AB - Objectives: To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in rheumatoid arthritis (RA)Methods: Paired DAS28-ESR and DAS28-CRP readings (n=31,074) were obtained from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated. Results: DAS28-CRP scores were ~0.3 lower than DAS28-ESR overall, with greatest differences for women (-0.35) and patients over 50 years old (-0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity (LDA) and remission thresholds (32.0% and 66.6% concordance respectively). Adjusting DAS28-CRP scores by gender significantly (p <0.001) improved agreement with the DAS28-ESR. Conclusion: Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.

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DO - 10.1093/rheumatology/key374

M3 - Article

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

ER -